Development and feasibility testing of a buddy intervention to increase postnatal physical activity

Childbirth is a life event that negatively influences mothers’ physical activity (PA) levels and is identified as a teachable moment for health behaviour change and therefore interventions to increase postnatal PA are required. This thesis broadly follows the first two steps in the Medical Research Council (MRC) intervention development guidance, combined with methods from the Behaviour Change Wheel (BCW). The first study systematically reviewed the existing literature on the effectiveness of postnatal PA interventions. Eleven studies were included in the narrative review and eight in the meta-analysis. There was a small but significant increase in PA behaviour in the intervention group compared to the control group, but heterogeneity was high. A need for interventions with larger sample sizes, longer follow-up periods and objective PA measurements was identified. Study two utilised a multi-methods design to explore the factors that influence postnatal PA according to the COM-B model of behaviour. Semi-structured interviews qualitatively explored participants’ views on what factors influenced PA, and a questionnaire determined their relative importance. Qualitative findings indicated that all COM-B components influenced behaviour, and quantitative findings indicated that the most important factors that influenced behaviour were time, feeling tired, lack of available childcare, lack of advice from a healthcare professional, lack of motivation and development of a habit. The results are presented in a behavioural analysis for postnatal PA. The next section of this thesis described the remaining steps of the BCW to identify intervention options, content and implementation options resulting in ‘Buddy Up’, an intervention that matches two new mothers as PA buddies to provide mutual support to increase PA. A buddy is an existing friend or another eligible participant. The intervention includes three PA counselling sessions based on Motivational Interviewing principles supplemented by a booklet. The final study explored the feasibility of delivering ‘Buddy Up’ utilising a single group pre-post study design. The study explored the feasibility of recruitment, data collection, intervention acceptability and preliminary efficacy data. 44 participants (existing friends (n=22); new match (n=22)) were recruited, and 21 participants 5 remained unmatched. Key recruitment challenges were engaging Children’s Centres (CCs) with recruitment and matching participants. Participants engaged in PA with their buddy on 1.06 days (SD=1.76) in the past week and provided support by sending encouraging messages (85.7%), sharing PA ideas/information (71.4%) and doing PA together (60%). Findings from the post-intervention interviews suggest good acceptability of the intervention sessions, minimal usage of the booklet and varied views on the acceptability of the buddy element among participants. Preliminary effectiveness data is promising for objective (Baseline=697.68 counts per minute (cpm); Follow-up=765.05 cpm) and self-report PA (Baseline=1533.56 MET-min/week; Follow-up=1917.50 MET-min/week) and has a significant effect on self-efficacy to overcome some barriers to PA (when feeling depressed, when there is no one to be physically active with, during bad weather and when they have no money). Collectively, this thesis describes the intervention development process and presents the first buddy intervention for postnatal physical activity. The feasibility study findings show promise that this is a fruitful research avenue, but the intervention’s operational feasibility requires further refinement prior to recommending a large-scale efficacy trial.This study was funded by the National Institute for Health Research (NIHR) School for Primary Care Research. The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care

Changing the Face of STEM: Review of Literature on The Role of Mentors in the Success of Undergraduate Black Women in STEM Education

The lack of ethnic and gender diversity in STEM undergraduate programs may lead to diversity and equity issues in STEM careers. However, some research suggests that mentoring influences the career trajectory of Black undergraduate women students in STEM. The investigation into these phenomena highlights suggestions for future research on mentoring Black undergraduate women in STEM. More recently, empirical research on mentoring among Black women have gained some momentum. Furthermore, with the increasing diversity and inclusivity demands from #ShutdownSTEM, in support of the Black Lives Matter movement, there is a focus on correcting barriers to access in STEM. Therefore, this conceptual paper reviews the literature on mentoring undergraduate Black women in STEM, effective mentoring best practices, and future research and policymaking suggestions

A qualitative investigation of non-response in NHS health checks

Background Improving uptake of NHS Health Checks has become a priority in England, but there is a lack of data on the perceptions of programme non-attenders. This study aimed to explore how non-attenders of NHS Health Checks perceive the programme, identify reasons for non-attendance and inform strategies to improve uptake. Method This qualitative study involved individuals registered at four general practices in Stoke-on-Trent, UK, who had not taken up their invitation to a NHS Health Check. Semi-structured face-to-face and telephone interviews were audio-recorded and transcribed verbatim for Thematic Analysis. Results Interviews were completed with 19 males and 22 females (mean age 52.9 ± 8.5 years), who were socio-demographically representative of the non-attender population. Four main themes identified related to: the positive perception of the Health Check concept among non-attenders; the perceived lack of personal relevance; ineffective invitation method and appointment inconvenience were common barriers; previous experience of primary care can influence uptake. Conclusions Fundamental requirements for improving uptake are that individuals recognise the personal relevance of Health Checks and that attendance is convenient. Incorporating more sophisticated and personalised risk communication as part of the invitation could increase impact and promote candidacy. Flexibility and convenience of appointments should be considered by participating general practices. Keywords Health check Mass screening Cardiovascular diseases Qualitative researc

A systematic review of the relationship between socio-economic position and physical activity

Objective \ud The aim of the present review was to examine epidemiological evidence to determine if there is strong evidence of a positive gradient of increasing physical activity across the socio-economic strata, and how relationships are affected by socio-economic measurement.\ud \ud Design \ud Systematic review.\ud \ud Method \ud A search of major databases was conducted to identify published studies that reported physical activity in relation to socio-economic position (SEP) in adults.\ud Results Twenty-eight cross-sectional and five longitudinal studies met the inclusion criteria. Approximately half of these were American. Consequently education and income were most commonly used to represent SEP. The majority of studies were secondary analyses of existing health survey data, which could explain the generally large sample sizes and methodological weaknesses in physical activity and SEP measurement. There was consistent evidence of a higher prevalence or higher levels of leisure-time or moderate-vigorous intensity physical activity in those at the top of the socio-economic strata compared with those at the bottom. Evidence for positive gradients across the socio-economic strata was less consistent. Education produced the most stable relationships, less susceptible to confounding effects of ethnicity and the environment.\ud \ud Conclusion \ud Those at the top of the socio-economic scale appear to perform more leisure-time activity than those at the bottom. Diverse and often crude physical activity and socio-economic measurement made it difficult to distinguish between artefact and true effect in a relationship with so many potential confounding influences. Further studies using up-to-date methods of socio-economic and physical activity measurement are necessary to further explore this relationship and its confounders

A systematic review of the relationship between socio-economic position and physical activity

Objective The aim of the present review was to examine epidemiological evidence to determine if there is strong evidence of a positive gradient of increasing physical activity across the socio-economic strata, and how relationships are affected by socio-economic measurement. Design Systematic review. Method A search of major databases was conducted to identify published studies that reported physical activity in relation to socio-economic position (SEP) in adults. Results Twenty-eight cross-sectional and five longitudinal studies met the inclusion criteria. Approximately half of these were American. Consequently education and income were most commonly used to represent SEP. The majority of studies were secondary analyses of existing health survey data, which could explain the generally large sample sizes and methodological weaknesses in physical activity and SEP measurement. There was consistent evidence of a higher prevalence or higher levels of leisure-time or moderate-vigorous intensity physical activity in those at the top of the socio-economic strata compared with those at the bottom. Evidence for positive gradients across the socio-economic strata was less consistent. Education produced the most stable relationships, less susceptible to confounding effects of ethnicity and the environment. Conclusion Those at the top of the socio-economic scale appear to perform more leisure-time activity than those at the bottom. Diverse and often crude physical activity and socio-economic measurement made it difficult to distinguish between artefact and true effect in a relationship with so many potential confounding influences. Further studies using up-to-date methods of socio-economic and physical activity measurement are necessary to further explore this relationship and its confounders

“They are saying it’s high, but I think it’s quite low”: exploring cardiovascular disease risk communication in NHS health checks through video-stimulated recall interviews with patients – a qualitative study

Background: NHS Health Check (NHSHC) is a national cardiovascular disease (CVD) risk identification and management programme. However, evidence suggests a limited understanding of the most used metric to communicate CVD risk with patients (10-year percentage risk). This study used novel application of video-stimulated recall interviews to understand patient perceptions and understanding of CVD risk following an NHSHC that used one of two different CVD risk calculators. Methods: Qualitative, semi-structured video-stimulated recall interviews were conducted with patients (n = 40) who had attended an NHSHC using either the QRISK2 10-year risk calculator (n = 19) or JBS3 lifetime CVD risk calculator (n = 21). Interviews were transcribed and analysed using reflexive thematic analysis. Results: Analysis resulted in the development of four themes: variability in understanding, relief about personal risk, perceived changeability of CVD risk, and positive impact of visual displays. The first three themes were evident across the two patient groups, regardless of risk calculator; the latter related to JBS3 only. Patients felt relieved about their CVD risk, yet there were differences in understanding between calculators. Heart age within JBS3 prompted more accessible risk appraisal, yet mixed understanding was evident for both calculators. Event-free survival age also resulted in misunderstanding. QRISK2 patients tended to question the ability for CVD risk to change, while risk manipulation through JBS3 facilitated this understanding. Displaying information visually also appeared to enhance understanding. Conclusions: Effective communication of CVD risk within NHSHC remains challenging, and lifetime risk metrics still lead to mixed levels of understanding in patients. However, visual presentation of information, alongside risk manipulation during NHSHCs can help to increase understanding and prompt risk-reducing lifestyle changes. Trial registration: ISRCTN10443908. Registered 7th February 2017

How is suicide risk assessed in healthcare settings in the UK? A systematic scoping review

A high proportion of people contact healthcare services in the 12 months prior to death by suicide. Identifying people at high-risk for suicide is therefore a key concern for healthcare services. Whilst there is extensive research on the validity and reliability of suicide risk assessment tools, there remains a lack of understanding of how suicide risk assessments are conducted by healthcare staff in practice. This scoping review examined the literature on how suicide risk assessments are conducted and experienced by healthcare practitioners, patients, carers, relatives, and friends of people who have died by suicide in the UK. Literature searches were conducted on key databases using a pre-defined search strategy pre-registered with the Open Science Framework and following the PRISMA extension for scoping reviews guidelines. Eligible for inclusion were original research, written in English, exploring how suicide risk is assessed in the UK, related to administering or undergoing risk assessment for suicide, key concepts relating to those experiences, or directly exploring the experiences of administering or undergoing assessment. Eighteen studies were included in the final sample. Information was charted including study setting and design, sampling strategy, sample characteristics, and findings. A narrative account of the literature is provided. There was considerable variation regarding how suicide risk assessments are conducted in practice. There was evidence of a lack of risk assessment training, low awareness of suicide prevention guidance, and a lack of evidence relating to patient perspectives of suicide risk assessments. Increased inclusion of patient perspectives of suicide risk assessment is needed to gain understanding of how the process can be improved. Limited time and difficulty in starting an open discussion about suicide with patients were noted as barriers to successful assessment. Implications for practice are discussed